Healthcare Provider Details

I. General information

NPI: 1447264874
Provider Name (Legal Business Name): DONA ANA MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 E LOHMAN AVE SUITE #4
LAS CRUCES NM
88011-8296
US

IV. Provider business mailing address

3851 E LOHMAN AVE SUITE #4
LAS CRUCES NM
88011-8296
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-5931
  • Fax: 575-522-4532
Mailing address:
  • Phone: 575-522-5931
  • Fax: 575-522-4532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number02946075001
License Number StateNM

VIII. Authorized Official

Name: MR. ABRAHAM THOMAS GONZALEZ
Title or Position: OWNER/MANAGER/REG. RESP. THERAPIST
Credential: RRT
Phone: 575-644-2701